Comparison of the effects of albumin and crystalloid on mortality among patients with septic shock: systematic review with meta-analysis and trial sequential analysis

Abstract

Sepsis is a life-threatening organ dysfunction caused by a disordered response of the body to infection. 1 Septic shock is a phenomenon relating to sepsis and is a serious disorder involving both the circulatory system and cell metabolism. During septic shock, extremely low blood pressure is observed, and this requires use of a vasoactive drug after adequate volumetric resuscitation has been applied, in order to maintain average blood pressure ≥ 65 mmHg and lactate concentration ≥ 2 mmol/l. Septic shock is the most life-threatening subtype of sepsis, with a mortality rate of 20% to 45%. 2 Fluid resuscitation is a key component of treatments for sepsis and septic shock. Over the past 30 years, many randomized clinical trials (RCTs) and systematic reviews 3-8 that evaluated the therapeutic effects of various fluid resuscitation therapies on sepsis concluded that crystalloid and albumin were the most beneficial therapeutic agents, while use of artificial colloid was associated with a higher death rate and with adverse events. However, few RCTs and systematic reviews have compared the therapeutic effects of crystalloid and albumin regarding septic shock. 9-13 Moreover, the researchers involved in the studies available differed in their conclusions. 14-21 According to the findings from the Enhanced Recovery after Surgery (ERAS) study, 14 albumin does not reduce the mortality rate due to septic shock, whereas the findings from another large RCT called ALBIOS (NCT00707122) 15 concluded that fluid resuscitation using albumin could reduce the mortality rate from septic shock. In 2014, contrary results were reported in a meta-analysis by Patel et al., 16 which found that there was no difference between the effects from albumin and crystalloid treatment, while another meta-analysis by Xu et al. 17 reported that albumin treatment had positive results with regard to reducing the mortality rate among adult patients with septic shock. These studies have shown that it is not yet a foregone conclusion that albumin is superior to crystalloid for reducing the mortality rate in septic shock cases. In 2015, the Lactated Ringer Versus Albumin in Early Sepsis Therapy (RASP) RCT (NCT01337934) 18 specifically compared 4%

Different concentrations of albumin versus crystalloid in patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials

“…These ndings were consistent with those in a previous meta-analysis published in 2014 [9]. Nevertheless, our results on the bene cial effect of albumin in decreasing the mortality in septic shock patients were contradictory to those from a study published in 2018 [11]. This could be due to the variance of the included studies and the corresponding patient number, since one extra RCT published recently was added [13].…”

“…One study revealed that albumin treatment could reduce the 90-day mortality in patients with severe sepsis and septic shock compared with crystalloid [9]. However, another study concluded that albumin is unable to decrease the mortality [11]. Our meta-analysis aimed to provide an update on the impact of albumin in resuscitating patients with severe sepsis and septic shock with inclusion of the most recent RCTs.…”

“…Additionally, some meta-analyses revealed the contradictory conclusions on the effects of albumin treatment. Some studies showed that albumin signi cantly improved the survival rate of patients with severe sepsis or septic shock [9], while some others found no differences between albumin and crystalloid treatment in the reduction of the rate of mortality [10,11]. Therefore, the results of the above studies did not show a unanimous conclusion.…”

Predictive Nomogram of the in-Hospital Mortality of Patients with Cardiogenic Shock

“…22,24 The infusion of albumin as a volume expander or as an alternative to using crystalloids for volume replacement is performed in patients with shock and severe sepsis; however, evidence that its use in critically ill patients improves survival is limited. 25,26 Although improvements in hemodynamic instability can be achieved with the administration of albumin, long-term bene ts require further investigation. 25 Among patients with heart failure or ACS, hypoalbuminemia is correlated with higher overall illness severity and low levels of albumin can act as a frailty biomarker; therefore, it is consistently associated with higher mortality rates.…”

Does the use of albumin in adults with septic shock in the ICU decrease mortality?

“…A 2018 meta-analysis of six randomized controlled trials (RCTs; N=3,088) compared the effects of albumin and crystalloid on mortality in patients with septic shock. 1 With the exception of one paper published in 1983, all other papers included patients with septic shock managed within the intensive care unit (ICU) setting. Patients' median or mean ages were between 58 and 79 years old, with 35% to 44% females, and drawn from 10 countries of America, Europe, and Oceania from 1983 to 2015.…”